两种固定方式治疗跟骨骨折的疗效比较

Comparison effects of two fixation methods in the treatment of calcaneal fractures

目的比较两种固定方式治疗跟骨骨折的疗效。方法将80例跟骨骨折患者按照固定方式的不同分为切开复位内固定组(切开复位组,38例)和闭合撬拨复位石膏外固定组(撬拨复位组,42例)。比较两组手术时间、术中出血量、住院费用、术后并发症发生情况以及手术前后跟骨长度、高度、宽度、结节关节角、交叉角情况。末次随访时采用Maryland评分标准评价足功能。结果患者均获得随访,时间6~13个月。(1)手术时间、术中出血量、住院费用撬拨复位组均明显短(少)于切开复位组(P <0.01)。(2)跟骨相关指标两组术后均明显优于术前(P <0.05);术后跟骨长度、高度、宽度两组比较差异均无统计学意义(P> 0.05);术后、末次随访时跟骨结节关节角及交叉角两组比较差异均有统计学意义(P <0.05)。(3)末次随访时Maryland评分及优良率切开复位组均明显高于撬拨复位组(P <0.05)。(4)足跟痛两组比较差异无统计学意义(P> 0.05);创伤性关节炎、切口裂开发生率两组比较差异均有统计学意义(P <0.05)。结论闭合撬拨复位石膏外固定与切开复位内固定治疗跟骨骨折均疗效满意,但切开复位治疗远期效果较佳,撬拨复位治疗手术时间较短、术中出血量及住院费用较少。

Objective To compare the efficacy of two fixation methods in the treatment of calcaneal fractures. Methods Eighty patients with calcaneal fracture were divided into open reduction and internal fixation group( open reduction group,38 cases) and closed prying reduction plaster external fixation group( prying reduction group,42 cases).The operative time,intraoperative bleeding volume,hospitalization cost,complications situation and the length,height,width of calcaneus,the B9 hler angle and Gissane angle were compared between two groups. The foot function was evaluated by Maryland score criterion at the last follow-up. Results All patients were followed up for 6 ~ 13 months.(1)The operation time,intraoperative blood loss and hospitalization cost of prying reduction group were significantly shorter( less) than those of open reduction group( P < 0. 01) .(2) At the postoperation,the related indexes of calcaneus in two groups were significantly better than the preoperation( P < 0. 05);there were no significant differences in the length,height and width of the calcaneus between the two groups( P > 0. 05);there were significant differences in the B9 hler angle and Gissane angle between the two groups at the postoperation and last follow-up( P < 0. 05) .(3) At the last follow-up,Maryland score and excellent-good rate in the open reduction group were significantly higher than those in the prying reduction group( P < 0. 05) .(4) There was no significant difference in heel pain between the two groups( P > 0. 05);there were significant differences in the incidence rate of traumatic arthritis and incision dehiscence between the two groups( P < 0. 05). Conclusions It is satisfactory for closed prying reduction plus plaster external fixation and open reduction internal fixation in the treatment of calcaneal fractures,but the long-term effect of open reduction is better;for prying reduction,the operation time is shorter,the intraoperative blood loss and the hospitalization cost are less.